1
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Greiner RC, Kohlberg GD, Lu GN. Management of facial nerve trauma. Curr Opin Otolaryngol Head Neck Surg 2024; 32:234-238. [PMID: 38695542 DOI: 10.1097/moo.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
PURPOSE OF REVIEW To present the current literature on management of facial nerve disorder secondary to trauma, with a focus on the utility of electrodiagnostic testing in this setting. RECENT FINDINGS Patients with facial palsy related to temporal bone fractures should be started on high-dose corticosteroids as early as possible. Recent literature on the benefit of surgical intervention in the setting of temporal bone fracture is mixed. Some studies support early surgical decompression whereas others have found no benefit compared with conservative treatment. SUMMARY The management of facial nerve trauma is based on location and extent of injury. Extratemporal trauma and transected nerve should be treated with surgical exploration and tension-free coaptation ideally within 72 h. There are no guidelines for intratemporal facial nerve trauma. Surgical decompression compared with medical management is debated in the literature without consensus and more large studies are needed.
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Affiliation(s)
| | - Gavriel D Kohlberg
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
| | - G Nina Lu
- University of Washington Department of Otolaryngology - Head and Neck Surgery, Seattle, Washington, USA
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2
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Xu L, Guo T, Sheng X, Du H, Tang Y. Predictive Value of the Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Idiopathic Facial Nerve Palsy. Int J Gen Med 2024; 17:2635-2642. [PMID: 38863739 PMCID: PMC11166163 DOI: 10.2147/ijgm.s458808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/01/2024] [Indexed: 06/13/2024] Open
Abstract
Objective This study aims to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in patients with idiopathic facial nerve palsy. Methods The clinical data of patients with idiopathic facial nerve palsy were retrospectively analyzed. After three months of follow-up, patients were divided into good prognosis and poor prognosis, and the correlation between NLR, CRP and idiopathic facial nerve palsy was analyzed. Results Negative correlation of NLR with Portmann score in idiopathic facial nerve palsy (r=-0.788, P<0.05); In contrast to the group with poor prognosis, patients in good prognosis group had low levels of body mass index (BMI), NLR, and C-reactive protein (CRP), and high Portmann score (P<0.05); Multivariate logistic regression analysis showed Portmann score (OR=1.268, 95% CI (1.005-1.616)), NLR (OR=0.262, 95% CI (0.128-0.533)) and CRP levels (OR=0.949, 95% CI (0.895-0.989)) were risk factors of poor prognosis for patients with idiopathic facial nerve palsy. The area under the receiver operator characteristic (ROC) curve of NLR and CRP levels in predicting poor facial nerve function was 0.764 and 0.697, the specificity was 85.5% and 75.0%, and the sensitivity was 74. 0% and 76.0%, respectively. The ROC curve of the combined diagnosis was 0.829, the specificity was 80.7%, and the sensitivity was 82.0%. Conclusion Elevated NLR and CRP are associated with a poor prognosis of idiopathic facial nerve palsy and can serve as an indicator for clinical prognosis, and can be widely used in clinical.
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Affiliation(s)
- Longdong Xu
- Department of Neurology, Changshu NO.5 People’s Hospital, Changshu, Jiangsu, 215500, People’s Republic of China
| | - Tingting Guo
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Xihua Sheng
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Huaping Du
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Ying Tang
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
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3
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Sun P, Li C, Yang C, Sun M, Hou H, Guan Y, Chen J, Liu S, Chen K, Ma Y, Huang Y, Li X, Wang H, Wang L, Chen S, Cheng H, Xiong W, Sheng X, Zhang M, Peng J, Wang S, Wang Y, Yin L. A biodegradable and flexible neural interface for transdermal optoelectronic modulation and regeneration of peripheral nerves. Nat Commun 2024; 15:4721. [PMID: 38830884 PMCID: PMC11148186 DOI: 10.1038/s41467-024-49166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
Optoelectronic neural interfaces can leverage the photovoltaic effect to convert light into electrical current, inducing charge redistribution and enabling nerve stimulation. This method offers a non-genetic and remote approach for neuromodulation. Developing biodegradable and efficient optoelectronic neural interfaces is important for achieving transdermal stimulation while minimizing infection risks associated with device retrieval, thereby maximizing therapeutic outcomes. We propose a biodegradable, flexible, and miniaturized silicon-based neural interface capable of transdermal optoelectronic stimulation for neural modulation and nerve regeneration. Enhancing the device interface with thin-film molybdenum significantly improves the efficacy of neural stimulation. Our study demonstrates successful activation of the sciatic nerve in rodents and the facial nerve in rabbits. Moreover, transdermal optoelectronic stimulation accelerates the functional recovery of injured facial nerves.
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Affiliation(s)
- Pengcheng Sun
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Chaochao Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Can Yang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Mengchun Sun
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Hanqing Hou
- School of Life Sciences, Tsinghua University, Beijing, 100084, P. R. China
| | - Yanjun Guan
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Jinger Chen
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Shangbin Liu
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Kuntao Chen
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
| | - Yuan Ma
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Yunxiang Huang
- Thayer School of Engineering, Dartmouth College, Hanover, NH, 03755, USA
| | - Xiangling Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P. R. China
| | - Huachun Wang
- School of Integrated Circuits, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, P. R. China
| | - Liu Wang
- School of Biological Science and Medical Engineering, Key Laboratory of Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, P. R. China
- School of Engineering Medicine, Beihang University, Beijing, 100083, P. R. China
| | - Shengfeng Chen
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Haofeng Cheng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
| | - Wei Xiong
- Chinese Institute for Brain Research, Beijing, 102206, P. R. China
| | - Xing Sheng
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China
- Institute for Precision Medicine, Tsinghua University, Beijing, 100084, P. R. China
- IDG/McGovern Institute for Brain Research, Tsinghua University, Beijing, 100084, P. R. China
| | - Milin Zhang
- Department of Electronic Engineering, Tsinghua University, Beijing, 100084, P. R. China
| | - Jiang Peng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226007, P. R. China
| | - Shirong Wang
- MegaRobo Technologies Co. ltd, Beijing, 100085, P. R. China.
| | - Yu Wang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing Key Lab of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma and Injuries PLA, No. 28 Fuxing Road, Beijing, 100853, P. R. China.
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, 226007, P. R. China.
| | - Lan Yin
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing, 100084, P. R. China.
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Daloiso A, Franz L, Mondello T, Pavone C, Spinato G, Emanuelli E, Cazzador D, de Filippis C, Zanoletti E, Marioni G. Post-traumatic Delayed Facial Nerve Palsy: Report of 2 Cases and Systematic Review. Otolaryngol Head Neck Surg 2024. [PMID: 38769871 DOI: 10.1002/ohn.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/13/2024] [Accepted: 05/04/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Delayed facial nerve palsy (dFNP) secondary to head injury is definitely uncommon. Although the mechanism of immediate facial nerve paralysis is well-studied, its delayed presentation remains debated. Given the dearth of available information, we reported herein our experience with 2 cases of posttraumatic dFNP. This systematic review aimed to evaluate all available information on dFNP and to assess treatment outcome also comparing conservatively and surgically approaches. DATA SOURCES Pubmed, Scopus, and Web of Science databases were systematically screened. REVIEW METHODS The protocol of this investigation was registered on PROSPERO in April 2023 and the systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. RESULTS Both patients in the case studies showed a complete recovery within 2 to 3 months after the head trauma. One of them still reported a subjective taste alteration at last control. After the application of the inclusion-exclusion criteria, 9 manuscripts with adequate relevance to this topic were included in the systematic review. The study population consisted of 1971 patients with a diagnosis of posttraumatic facial nerve palsy, of which 128 with a dFNP. CONCLUSIONS dFNP due to head trauma is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated. Based on the reported data, it seems rational to propose a conservative approach for dFNP with steroid administration as a first line in most cases, indicating surgery in severe and/or refractory cases.
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Affiliation(s)
- Antonio Daloiso
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Leonardo Franz
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
| | - Tiziana Mondello
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Chiara Pavone
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Giacomo Spinato
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Enzo Emanuelli
- Otolaryngology Unit, Ca' Foncello Hospital, Local Health Unit N.2 "Marca Trevigiana", Treviso, Italy
| | - Diego Cazzador
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Cosimo de Filippis
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
| | - Elisabetta Zanoletti
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Gino Marioni
- Department of Neuroscience DNS, Phoniatrics and Audiology Unit, University of Padua, Treviso, Italy
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Allevi F, Abate N, Bolognesi F, Tarabbia F, Rabbiosi D, Bellasio MM, Lozza A, Biglioli F. Is pre-operative electromyography a reliable tool in differentiating acute and chronic facial palsy? A preliminary evaluation in patients treated with triple innervation facial reanimation. J Craniomaxillofac Surg 2024:S1010-5182(24)00139-2. [PMID: 38734508 DOI: 10.1016/j.jcms.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/01/2024] [Indexed: 05/13/2024] Open
Abstract
Electromyographic evaluation is a reliable tool for confirming facial palsy and assessing its severity. It allows differentiating facial paresis and paralysis, and further distinguishes acute palsies, still showing muscle fibrillations, from chronic cases. This article aims to show that EMG fibrillations might represent a better criterion to differentiate acute and chronic palsies than the standard 18-24 months' cut-off usually employed for classification and treatment purposes. We performed a cohort study using the eFACE tool for comparing triple innervation facial reanimation results in patients with EMG fibrillation treated <12 months, 12-18 months, and >18 months from paralysis onset. Patients showed a statistically significant post-operative improvement in all eFACE items, both in the whole sample and in the three groups. Only the deviation from the optimal score for the gentle eye closure item in group 2 didn't reach statistical significance (p = 0.173). The post-operative results were comparable in the three groups, as the Kruskal-Wallis test showed a difference only for the platysmal synkinesis item scores, which were significantly lower in group 3 (p = 0.025).
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Affiliation(s)
- Fabiana Allevi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy.
| | - Nicole Abate
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Federico Bolognesi
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Filippo Tarabbia
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Dimitri Rabbiosi
- Department of Otorhinolaryngology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Federico Biglioli
- Maxillo-Facial Surgery Department, San Paolo Hospital, University of Milan, Milan, Italy
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6
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Misra I, Rath B, Rath I, Mondal H. Predictors of Recovery in Facial Nerve Palsy: Insights From an Observational Study in Odisha, India. Cureus 2024; 16:e58949. [PMID: 38800142 PMCID: PMC11127665 DOI: 10.7759/cureus.58949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background Facial nerve paralysis, leading to the loss of facial expression, poses significant discomfort to patients. While most individuals exhibit a favorable response to treatment, a subset experiences enduring facial deformities without clearly defined etiology. This study aimed to identify prognostic factors influencing outcomes and quality of life in facial nerve palsy patients, contributing to enhanced clinical management. Methods A prospective observational study was conducted in the Otorhinolaryngology Department of Maharaja Krishna Chandra Gajapati Medical College and Hospital, a tertiary care hospital. We included patients presenting with any clinical variety of facial nerve palsy, irrespective of age and gender. Only moribund and noncompliant cases were excluded. Patients underwent clinical assessment using the House-Brackmann (HB) grading at presentation and were subsequently monitored at three weeks, three months, and six months post-onset to assess recovery. Results Out of 66 patients, 18 (27.27%) fully recovered at three weeks, 50 (75.76%) recovered at three months, and 54 (81.82%) at six-month follow-up. Incomplete recovery was observed in 13 (19.69%) patients. Factors associated with favorable outcomes included younger age of onset (p = 0.003), lower baseline HB grade (IV or less) (p = 0.001), Electroneurography Degeneration Index (ENoG DI) of <70% (p < 0.0001), early initiation of treatment (within five days of onset) (p = 0.0003), and absence of comorbid conditions (p = 0.03). Gender and affected side (left or right) did not influence the outcome. Conclusion In summary, age, associated comorbid conditions, baseline HB grade, and extent of facial nerve degeneration are crucial predictors of outcomes in facial nerve palsy. This knowledge can guide clinicians in optimizing treatment strategies for improved patient care.
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Affiliation(s)
- Ikhita Misra
- Otorhinolaryngology, Shri Jagannath Medical College and Hospital, Puri, IND
| | - Bandana Rath
- Pharmacology, Saheed Laxman Nayak Medical College and Hospital, Koraput, IND
| | - Ishani Rath
- Biochemistry, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, IND
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Kanona H, Saeed SR, Randhawa P, Kimber R, Rodger A, Khalil S, Andrews P. Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach. Facial Plast Surg 2024. [PMID: 38301715 DOI: 10.1055/s-0044-1779046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
This article aims to provide an overview of the management of facial palsy within a multidisciplinary team setting and discusses considerations used to develop patient-specific management plans. The national landscape of facial function services is also discussed including suggestions on what may enable a more equitable and sustainable service for the future.
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Affiliation(s)
- Hala Kanona
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Shakeel R Saeed
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Premjit Randhawa
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
| | - Rebecca Kimber
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Anne Rodger
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Sherif Khalil
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Peter Andrews
- The Royal National ENT Hospital, University College London Hospitals, London, United Kingdom
- The Royal National ENT Hospital and National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
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Franz L, Marioni G, Daloiso A, Biancoli E, Tealdo G, Cazzador D, Nicolai P, de Filippis C, Zanoletti E. Facial Surface Electromyography: A Novel Approach to Facial Nerve Functional Evaluation after Vestibular Schwannoma Surgery. J Clin Med 2024; 13:590. [PMID: 38276096 PMCID: PMC10816927 DOI: 10.3390/jcm13020590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. METHODS Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. RESULTS In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5-3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman's model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman's rho: 0.8268, p < 0.0001). CONCLUSIONS We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG.
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Affiliation(s)
- Leonardo Franz
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Antonio Daloiso
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Elia Biancoli
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Giulia Tealdo
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Diego Cazzador
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Piero Nicolai
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Cosimo de Filippis
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Elisabetta Zanoletti
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
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9
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Zhou W, Wang Z, Xu Q, Liu X, Li J, Yu H, Qiao H, Yang L, Chen L, Zhang Y, Huang Z, Pang Y, Zhang Z, Zhang J, Guan X, Ma S, Ren Y, Shi X, Yuan L, Li D, Huang D, Li Z, Jia W. Wireless facial biosensing system for monitoring facial palsy with flexible microneedle electrode arrays. NPJ Digit Med 2024; 7:13. [PMID: 38225423 PMCID: PMC10789865 DOI: 10.1038/s41746-024-01002-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
Facial palsy (FP) profoundly influences interpersonal communication and emotional expression, necessitating precise diagnostic and monitoring tools for optimal care. However, current electromyography (EMG) systems are limited by their bulky nature, complex setups, and dependence on skilled technicians. Here we report an innovative biosensing approach that utilizes a PEDOT:PSS-modified flexible microneedle electrode array (P-FMNEA) to overcome the limitations of existing EMG devices. Supple system-level mechanics ensure excellent conformality to the facial curvilinear regions, enabling the detection of targeted muscular ensemble movements for facial paralysis assessment. Moreover, our apparatus adeptly captures each electrical impulse in response to real-time direct nerve stimulation during neurosurgical procedures. The wireless conveyance of EMG signals to medical facilities via a server augments access to patient follow-up evaluation data, fostering prompt treatment suggestions and enabling the access of multiple facial EMG datasets during typical 6-month follow-ups. Furthermore, the device's soft mechanics alleviate issues of spatial intricacy, diminish pain, and minimize soft tissue hematomas associated with traditional needle electrode positioning. This groundbreaking biosensing strategy has the potential to transform FP management by providing an efficient, user-friendly, and less invasive alternative to the prevailing EMG devices. This pioneering technology enables more informed decision-making in FP-management and therapeutic intervention.
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Affiliation(s)
- Wenjianlong Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Zhongyan Wang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Qin Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Xiangxiang Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, 100730, Beijing, China
| | - Junshi Li
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Huaiqiang Yu
- Sichuan Institute of Piezoelectric and Acousto-optic Technology, 400060, Chongqing, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China
| | - Lirui Yang
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China
| | - Liangpeng Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Yuan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Zhe Huang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Yuxing Pang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Zhitong Zhang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Jiayan Zhang
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Xiudong Guan
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Shunchang Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Yingjie Ren
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Xiaoyi Shi
- School of Integrated Circuits, Peking University, 100871, Beijing, China
| | - Linhao Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
| | - Deling Li
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), 100070, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China
| | - Dong Huang
- School of Integrated Circuits, Peking University, 100871, Beijing, China.
| | - Zhihong Li
- School of Integrated Circuits, Peking University, 100871, Beijing, China.
- Beijing Advanced Innovation Center for Integrated Circuits, 100871, Beijing, China.
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, National Center for Neurological Disorders, Capital Medical University, 100070, Beijing, China.
- China National Clinical Research Center for Neurological Diseases (NCRC-ND), 100070, Beijing, China.
- Beijing Neurosurgical Institute, Capital Medical University, 100070, Beijing, China.
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Wu D, Lan X, Litscher G, Zhao YL, Wu YQ, Dai RJ, Cao K, Wang Y, Chen LQ. Laser acupuncture and photobiomodulation therapy in Bell's palsy with a duration of greater than 8 weeks: a randomized controlled trial. Lasers Med Sci 2024; 39:29. [PMID: 38216803 PMCID: PMC10787006 DOI: 10.1007/s10103-023-03970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
To investigate the efficacy of laser acupuncture and photobiomodulation therapy in alleviating symptoms among patients diagnosed with Bell's palsy with duration of greater than 8 weeks. The randomized controlled trial has been performed from May 2021 to April 2023. Patients were eligible who had Bell's palsy with duration of greater than 8 weeks on out-patient Department of Otorhinolaryngology in Beijing Tongren Hospital. The laser acupuncture group received class IV laser treatment for 3 times per weeks, a total of 72 times. The control group received the same treatment procedure except the laser parameter. The primary outcome measures comprised House-Brackmann facial nerve grading system and electroneurography. Secondary outcome measures comprised Sunnybrook facial grading system, electromyography, and the blink reflex. A total of 84 participants were included (42 control group, 42 laser acupuncture group). After treatment, House-Brackmann facial nerve grading system (OR, 0.11; 95% CI, 0.04-0.30; P < 0.001), and the pathologic numbers of electroneuronography were statistically different between the laser acupuncture group and control group, including orbicularis oculi (OR,0.08; 95% CI, 0.02-0.21; P < 0.001), Frontalis muscle (OR,0.14; 95% CI, 0.05-0.39; P < 0.001), Orbicularis oris (OR,0.13; 95% CI, 0.04-0.36; P < 0.001), Ala nasi muscle (OR,0.06; 95% CI, 0.02-0.18; P < 0.001). In secondary outcomes, Sunnybrook facial grading system, has significant difference between the two groups (20.26; 95% CI, 14.69 to 25.83; P < 0.01). Latency by ENoG, include orbicularis oculi (-0.61; 95% CI, -0.43 to -0.09; P < 0.001), frontalis muscle (-0.12; 95% CI, -0.21 to -0.03; P < 0.01), orbicularis oris (-0.28; 95% CI, -0.41 to -0.16; P < 0.001), and ala nasi muscle (-0.26; 95% CI, -0.38 to -0.16; P < 0.001). All amplitudes of MUAPs and durations by electromyography (EMG) showed statistically significant differences compared with the control group after treatment. For the frontalis muscle, the amplitude of MUAPs was -64.23 (95% CI, -80.89 to -47.56; P < 0.001) and duration was -1.18 (95% CI, -1.49 to -0.87; P < 0.001). For orbicularis oris, amplitude of MUAPs was -29.82 (95% CI, -55.03 to -4.62; P = 0.02) and duration was -0.57 (95% CI, -0.94 to -0.20; P < 0.001). For depressor angulli oris, amplitude of MUAPs was -47.06 (95% CI, -62.15 to -31.97; P < 0.001) and duration was -2.21 (95% CI, -2.69 to -1.72; P < 0.001). Blink reflex, including R1 (OR, 0.03; 95% CI, 0.01-0.16; P < .001), R2 (OR, 0.04; 95% CI, 0.004-0.29; P < .001), and R2 latency differences (OR, 0.15; 95% CI, 0.05-0.51; P < .001), have significant difference between the two groups, respectively. The findings suggest that laser acupuncture relieve symptoms for patients with Bell's palsy with a duration of greater than 8 weeks.Trial registration: ClinicalTrials.gov Identifier: NCT05846217.
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Affiliation(s)
- Dong Wu
- Department of Traditional Chinese Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xin Lan
- Jococo Inc, Los Angeles, CA, USA
| | - Gerhard Litscher
- President of the International Society for Medical Laser Applications (ISLA transcontinental; since 2012), German Vice President of the German-Chinese Research Foundation (DCFG) for TCM (since 2014), Vice Chairperson, World Federation of Chinese Medicine Societies, Committee of Card. Rehab. (2023-2028), Honorary President of the European Federation of Acupuncture and Moxibustion Societies (2023), Honorary Professor of China Beijing International Acupuncture Training Center, China Academy of Chinese Medical Sciences (2023), Former Head of two Research Units at Medical University of Graz, 8036, Graz, Austria
| | - Yan-Ling Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun-Qing Wu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ru-Jun Dai
- TED Healthcare Technology Ltd (Beijing), Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Institute of Acupuncture-Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lu-Quan Chen
- Department of Traditional Chinese Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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11
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Rajangam J, Lakshmanan AP, Rao KU, Jayashree D, Radhakrishnan R, Roshitha B, Sivanandy P, Sravani MJ, Pravalika KH. Bell Palsy: Facts and Current Research Perspectives. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:203-214. [PMID: 36959147 DOI: 10.2174/1871527322666230321120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
Bell palsy is a non-progressive neurological condition characterized by the acute onset of ipsilateral seventh cranial nerve paralysis. People who suffer from this type of facial paralysis develop a droop on one side of their face, or sometimes both. This condition is distinguished by a sudden onset of facial paralysis accompanied by clinical features such as mild fever, postauricular pain, dysgeusia, hyperacusis, facial changes, and drooling or dry eyes. Epidemiological evidence suggests that 15 to 23 people per 100,000 are affected each year, with a recurrence rate of 12%. It could be caused by ischaemic compression of the seventh cranial nerve, which could be caused by viral inflammation. Pregnant women, people with diabetes, and people with respiratory infections are more likely to have facial paralysis than the general population. Immune, viral, and ischemic pathways are all thought to play a role in the development of Bell paralysis, but the exact cause is unknown. However, there is evidence that Bell's hereditary proclivity to cause paralysis is a public health issue that has a greater impact on patients and their families. Delay or untreated Bell paralysis may contribute to an increased risk of facial impairment, as well as a negative impact on the patient's quality of life. For management, antiviral agents such as acyclovir and valacyclovir, and steroid treatment are recommended. Thus, early diagnosis accompanied by treatment of the uncertain etiology of the disorder is crucial. This paper reviews mechanistic approaches, and emerging medical perspectives on recent developments that encounter Bell palsy disorder.
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Affiliation(s)
- Jayaraman Rajangam
- AMITY Institute of Pharmacy, AMITY University, Lucknow, Uttar Pradesh, 226028, India
| | | | - K Umamaheswara Rao
- Department of Pharmacology, Sri Venkateswara Institute of Medical Sciences, Sri Padmavati Mahila Visvavidyalayam, Tirupati, Andhra Pradesh, 517507, India
| | - D Jayashree
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O Box 505055, Dubai, UAE
| | - B Roshitha
- Sri Venkateswara Institute of Cancer Care and Advanced Research, Tirupati, Andhra Pradesh, 517507, India
| | - Palanisamy Sivanandy
- School of Pharmacy, International Medical University, No 126, Jalan Jalil Perkasa 19, Bukit Jalil 57000 Kuala Lumpur, Malaysia
| | - M Jyothi Sravani
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - K Hanna Pravalika
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
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12
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Rubin DI, Lamb CJ. The role of electrodiagnosis in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:43-59. [PMID: 38697746 DOI: 10.1016/b978-0-323-90108-6.00010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic (EDX) testing plays an important role in confirming a mononeuropathy, localizing the site of nerve injury, defining the pathophysiology, and assessing the severity and prognosis. The combination of nerve conduction studies (NCS) and needle electromyography findings provides the necessary information to fully assess a nerve. The pattern of NCS abnormalities reflects the underlying pathophysiology, with focal slowing or conduction block in neuropraxic injuries and reduced amplitudes in axonotmetic injuries. Needle electromyography findings, including spontaneous activity and voluntary motor unit potential changes, complement the NCS findings and further characterize chronicity and degree of axon loss and reinnervation. EDX is used as an objective marker to follow the progression of a mononeuropathy over time.
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Affiliation(s)
- Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
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Franz L, de Filippis C, Daloiso A, Biancoli E, Iannacone FP, Cazzador D, Tealdo G, Marioni G, Nicolai P, Zanoletti E. Facial surface electromyography: A systematic review on the state of the art and current perspectives. Am J Otolaryngol 2024; 45:104041. [PMID: 37716082 DOI: 10.1016/j.amjoto.2023.104041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/10/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Peripheral facial nerve palsy is a severely disabling condition. In current clinical practice, the commonest tools to assess facial palsy are grading scales, digital face image analyses or facial muscle electrophysiology. However, these techniques suffer from subjectivity or invasiveness and cannot be applied as part of a routine clinical assessment. Therefore, novel non-invasive office-based tools are needed. Surface electromyography (sEMG) may potentially fulfill the requirements of objectivity, low examiner-dependence, and minimal invasiveness. The aim of this systematic review is to define the state of the art on the use of sEMG for facial nerve functional assessment. MATERIALS AND METHODS Pubmed, Scopus and Web of Science databases were systematically searched. The study protocol was registered on PROSPERO in January 2023. The review was conducted according to the PRISMA guidelines. RESULTS After the application of inclusion-exclusion criteria, 15 manuscripts with adequate relevance to this topic were included in the review. CONCLUSIONS Facial sEMG represents a potentially useful tool to implement objective quantification of facial nerve function in clinical practice. Given the heterogeneity of methods and analysis in the available studies, sEMG results are hardly comparable. The introduction of methodological guidelines, followed by large prospective studies on well-defined subsets of patients with facial nerve impairment, is advocated.
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Affiliation(s)
- Leonardo Franz
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy; Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy; Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy
| | - Cosimo de Filippis
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy
| | - Antonio Daloiso
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy
| | - Elia Biancoli
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy
| | - Francesco Pio Iannacone
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy
| | - Diego Cazzador
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy
| | - Giulia Tealdo
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, 31100 Treviso, Italy.
| | - Piero Nicolai
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy
| | - Elisabetta Zanoletti
- Otolaryngology Section, Department of Neuroscience DNS, University of Padova, 35100 Padova, Italy
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Woo M, Yuk D, Choi SW, Lee J, Lee HH. Prognostic Value of Electroneuronography in Severe Cases of Facial Palsy. Ann Rehabil Med 2023; 47:511-518. [PMID: 37990500 PMCID: PMC10767212 DOI: 10.5535/arm.23082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/05/2023] [Accepted: 09/20/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To examine the prognostic value of electroneuronography (ENoG) in predicting functional recovery in severe cases of acute facial palsy. METHODS Patients with severe degrees of facial palsy (initial House-Brackmann [HB] grades IV to VI) with available electrodiagnostic studies conducted 2-4 weeks after symptom onset were reviewed retrospectively. The patients were categorized into "good recovery" and "poor recovery" groups, with the former showing mild to no dysfunction (HB I to III) and the latter exhibiting moderate to severe dysfunction (HB IV to VI) on follow-up evaluation, 2 months after onset. ENoG amplitudes in four facial muscles (frontalis, nasalis, orbicularis oculi, and orbicularis oris), as well as age, sex, affected side, disease etiology, comorbidities, and laboratory findings, were compared between the two groups. RESULTS Thirty-seven patients were included. Twenty-nine of the patients showed "good recovery," and eight showed "poor recovery" at 2 months after symptom onset. Univariate analysis yielded no significant difference in age, sex, affected side, disease etiology, comorbidities, and laboratory findings between the two groups. Preserved ENoG amplitudes (individual, average, and trimmed means) were significantly higher in the good recovery group than in the poor recovery group (p<0.005). Sex (p=0.038) and the ENoG of the nasalis muscle, acquired 2-4 weeks from symptom onset (p=0.004), showed significant differences in multivariate regression analysis. CONCLUSION This study suggests that the female sex and lower ENoG of the nasalis muscle, acquired 2-4 weeks from symptom onset, have negative prognostic value for the 2-month functional outcome of severe facial palsy cases.
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Affiliation(s)
- Minwoo Woo
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Doyoung Yuk
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Seo Won Choi
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Seoul, Korea
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Moncaliano MC, Ding P, Goshe JM, Genther DJ, Ciolek PJ, Byrne PJ. Clinical features, evaluation, and management of ophthalmic complications of facial paralysis: A review. J Plast Reconstr Aesthet Surg 2023; 87:361-368. [PMID: 37931512 DOI: 10.1016/j.bjps.2023.10.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 11/08/2023]
Abstract
The purpose of this review was to study the evaluation, diagnosis, and management of ophthalmic complications associated with facial nerve palsy and to discuss the current and future interventions. The ophthalmic complications of facial paralysis include lagophthalmos, ectropion, exposure keratopathy, ocular synkinesis, and crocodile tears. Evaluation by an ophthalmologist skilled in recognizing and managing complications of facial paralysis shortly after its initial diagnosis can help identify and prevent long-term complications. Several types of grading scales are used to evaluate, measure the severity, and track surgical and patient-reported treatment outcomes. Lagophthalmos or ectropion are managed using temporary measures aimed at lubricating and covering the eye, including scleral lenses; however, these measures can be expensive and challenging to acquire and maintain. Temporary surgical interventions include lateral tarsorrhaphy, weighted eyelid implants, lateral canthoplasty, and other procedures that tighten or lift the eyelid or surrounding tissues. Management of flaccid facial paralysis due to iatrogenic injury or neoplasm requires neurorrhaphy or graft repair. The most common techniques for dynamic reconstruction in chronic facial paralysis are regional and free muscle flap transfer. Future directions for the management of ophthalmic complications aim to induce blinking and eye closure by developing systems that can detect blinking in the normal eye and transmit the signal to the paralyzed eye using mechanisms that would stimulate the muscles to induce eyelid closure. Blink detection technology has been developed, and a study demonstrated that blinking can be stimulated using electrodes on the zygomatic branch of the facial nerve. Further studies are needed to develop a system that will automate blinking and synchronize it with that of the normal eye.
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Affiliation(s)
| | - Peng Ding
- Head and Neck Institute, Cleveland Clinic.
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Arnold D, Thielker J, Klingner CM, Guntinas-Lichius O, Volk GF. Selective zygomaticus muscle activation by ball electrodes in synkinetically reinnervated patients after facial paralysis. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1205154. [PMID: 37908489 PMCID: PMC10613664 DOI: 10.3389/fresc.2023.1205154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023]
Abstract
Introduction Although many different treatments were developed for facial palsy, only a few therapeutic options are available for facial synkinesis. Electrical stimulation of specific muscles via implants could be useful in restoring facial symmetry in synkinetic patients. A challenge in developing stimulation devices is finding the right stimulation location, type, and amplitude. This work assesses the ability to selectively stimulate the zygomaticus muscle (ZYG) in patients with oral-ocular synkinesis to elicit a visually detectable response of the ipsilateral corner of the mouth (COM), without causing a reaction of the orbicularis oculi muscle (OOM). We aimed to assess how close to the COM the stimulation should be delivered in order to be selective. Methods A total of 10 patients (eight females, two males) were enrolled. Facial function was graded according to the Sunnybrook facial grading system. Needle EMG was used to test the activities of the muscles, during volitional and "unintended" movements, and the degree of synkinesis of the ZYG and OOM. Two ball electrodes connected to an external stimulator were placed on the paretic ZYG, as close as possible to the COM. Results Independent of the waveform with which the stimulation was presented, a selective ZYG response was observed within 4.5 cm of the horizontal plane and 3 cm of the vertical plane of the COM. When the distance between the electrodes was kept to ≤2 cm, the amplitude necessary to trigger a response ranged between 3 and 6 mA when the stimulation was delivered with triangular pulses and between 2.5 and 3.5 mA for rectangular pulses. The required amplitude did not seem to be dependent on the applied phase duration (PD), as long as the PD was ≥5 ms. Conclusion Our results show that selective stimulation of the ZYG presenting synkinetic ZYG-OOM reinnervation can be achieved using a broad PD range (25-1,000 ms) and an average amplitude ≤6 mA, which may be further decreased to 3.5 mA if the stimulation is delivered via rectangular rather than triangular waves. The most comfortable and effective results were observed with PDs between 50 and 250 ms, suggesting that this range should be selected in future studies. Clinical Trial Registration [https://drks.de/search/de/trial/DRKS00019992], identifier (DRKS00019992).
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Affiliation(s)
- Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Carsten M. Klingner
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
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17
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Wu D, Zhao YL, Sun JY, Dai RJ, Cao K, Qu RK, Wang Y, Wu YQ. A Nonrandomized Trial of the Effects of Near-Infrared Photobiomodulation Therapy on Bell's Palsy with a Duration of Greater Than 8 Weeks. Photobiomodul Photomed Laser Surg 2023; 41:490-500. [PMID: 37738368 DOI: 10.1089/photob.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Objective: To determine whether photobiomodulation therapy (PBMT) by class IV Multiwave Locked System laser treatment as an adjunctive therapy could relieve symptoms in patients with Bell's palsy with a duration of greater than 8 weeks. Materials and methods: This nonrandomized controlled trial was conducted from January 2020 to December 2022. Patients were eligible if they had Bell's palsy with a duration of greater than 8 weeks at the out-patient department of otorhinolaryngology in Beijing Tongren Hospital. The control group consisted of patients recruited between January 1, 2020, and December 31, 2020. The PBMT group consisted of patients recruited between January 1, 2021, and December 31, 2022. In this study, the PBM used has a wavelength of 808 and 905 nm, 1.2 W power (808 nm is 1 W, 905 nm is 200 mW), continuous mode emission (808 nm) and pulsed mode emission (905 nm), 8.35 J/cm2 dosimetry, administered 3 times per week, 72 times of total treatment. The primary outcome measures included the House-Brackmann facial nerve grading system, the Sunnybrook facial grading system, and the Facial Clinimetric Evaluation Scale (FaCE). Secondary outcome measures comprised electroneurography, electromyography, and the blink reflex. Results: A total of 54 participants were included (27 in the control group and 27 in the photobiomodulation group). After 6 months, the House-Brackmann grading system [risk difference, -0.59, confidence interval (95% CI), -0.81 to -0.38, relative risk, 0.27, 95% CI, 0.13-0.56, p < 0.001], Sunnybrook facial grading system (21.14, 95% CI, 11.71-30.58; p < 0.001), and FaCE (-0.20, 95% CI, 0.41-0.02; p = 0.07) had significant difference between the two groups. Latency of ala nasi muscle (10.92, 95% CI, 5.58-16.27; p < 0.001) was not statistically significant after treatment compared with the control group; however, most of the electrophysiological examinations have significant difference between the two groups, respectively. Conclusions: The results of this study suggest that PBMT may relieve symptoms for patients with Bell's palsy with a duration of greater than 8 weeks. Trial Registration: ClinicalTrials.gov Identifier: NCT05585333.
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Affiliation(s)
- Dong Wu
- Department of Traditional Chinese Medicine and Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan-Ling Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing-Yi Sun
- Department of Oncology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ru-Jun Dai
- TED Healthcare Technology Ltd (Beijing), Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong-Kun Qu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Institute of Acupuncture-Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yun-Qing Wu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Hu W, Ding W, Jiang J, Wang L. Different Cortical Activation of Facial Synkinesis Patients with Different Course of Disease: A Task fMRI Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083067 DOI: 10.1109/embc40787.2023.10339996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Facial synkinesis is a disease characterized by unintentional activation of facial muscles, which causes that the patients cannot control their facial expressions independently. Previous studies have shown that its pathogenesis is related to the reorganization of cerebral cortex, but it remains unclear what brain changes the patients have at different stage of the disease. For this study, we recruited 30 patients with facial synkinesis and 19 healthy control subjects from Shanghai Huashan Hospital. All participants completed bilateral blinking and grinning tasks while functional magnetic resonance imaging (fMRI) data was collected. We measured the brain activation strength of each task and observed the activation similarity of the ipsilateral tasks. Then we explored the correlation between activation pattern and clinical scale. Results showed different activation pattern along the courses of disease for blinking and grinning task, which may be due to the inconsistent process of cortical reorganization. The late stage group activated more in blinking task, but the least in grinning tasks, especially on the affected side (p<0.001 at voxel level, p<0.05 at cluster level, FWE corrected). Compared with healthy controls, the activation of patients between tasks on the affected side is more similar(p<0.05). There was a negative correlation in right postcentral gyrus between activation similarity and scale scores (symmetry of voluntary movement scores: R = -0.469, p = 0.009). This could be attributed to the rearrangement of the nervous system following facial nerve injury, leading to incorrect connections between nerves and muscles. Our study may be helpful for understanding mechanism of facial synkinesis and provide basis for the stage-dependent diagnosis and treatment.
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Trentzsch V, Mueller N, Heinrich M, Kuttenreich AM, Guntinas-Lichius O, Volk GF, Anders C. Test-retest reliability of high-resolution surface electromyographic activities of facial muscles during facial expressions in healthy adults: A prospective observational study. Front Hum Neurosci 2023; 17:1126336. [PMID: 36992792 PMCID: PMC10040741 DOI: 10.3389/fnhum.2023.1126336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
ObjectivesSurface electromyography (sEMG) is a standard method for psycho-physiological research to evaluate emotional expressions or in a clinical setting to analyze facial muscle function. High-resolution sEMG shows the best results to discriminate between different facial expressions. Nevertheless, the test-retest reliability of high-resolution facial sEMG is not analyzed in detail yet, as good reliability is a necessary prerequisite for its repeated clinical application.MethodsThirty-six healthy adult participants (53% female, 18–67 years) were included. Electromyograms were recorded from both sides of the face using an arrangement of electrodes oriented by the underlying topography of the facial muscles (Fridlund scheme) and simultaneously by a geometric and symmetrical arrangement on the face (Kuramoto scheme). In one session, participants performed three trials of a standard set of different facial expression tasks. On one day, two sessions were performed. The two sessions were repeated two weeks later. Intraclass correlation coefficient (ICC) and coefficient of variation statistics were used to analyze the intra-session, intra-day, and between-day reliability.ResultsFridlund scheme, mean ICCs per electrode position: Intra-session: excellent (0.935–0.994), intra-day: moderate to good (0.674–0.881), between-day: poor to moderate (0.095–0.730). Mean ICC’s per facial expression: Intra-session: excellent (0.933–0.991), intra-day: good to moderate (0.674–0.903), between-day: poor to moderate (0.385–0.679). Kuramoto scheme, mean ICC’s per electrode position: Intra-session: excellent (0.957–0.970), intra-day: good (0.751–0.908), between-day: moderate (0.643–0.742). Mean ICC’s per facial expression: Intra-session: excellent (0.927–0.991), intra-day: good to excellent (0.762–0.973), between-day: poor to good (0.235–0.868). The intra-session reliability of both schemes were equal. Compared to the Fridlund scheme, the ICCs for intra-day and between-day reliability were always better for the Kuramoto scheme.ConclusionFor repeated facial sEMG measurements of facial expressions, we recommend the Kuramoto scheme.
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Affiliation(s)
- Vanessa Trentzsch
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Nadiya Mueller
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Martin Heinrich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Anna-Maria Kuttenreich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
- *Correspondence: Orlando Guntinas-Lichius, ; orcid.org/0000-0001-9671-0784
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
- Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Christoph Anders
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Sato W, Kochiyama T. Crosstalk in Facial EMG and Its Reduction Using ICA. SENSORS (BASEL, SWITZERLAND) 2023; 23:2720. [PMID: 36904924 PMCID: PMC10007323 DOI: 10.3390/s23052720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
There is ample evidence that electromyography (EMG) signals from the corrugator supercilii and zygomatic major muscles can provide valuable information for the assessment of subjective emotional experiences. Although previous research suggested that facial EMG data could be affected by crosstalk from adjacent facial muscles, it remains unproven whether such crosstalk occurs and, if so, how it can be reduced. To investigate this, we instructed participants (n = 29) to perform the facial actions of frowning, smiling, chewing, and speaking, in isolation and combination. During these actions, we measured facial EMG signals from the corrugator supercilii, zygomatic major, masseter, and suprahyoid muscles. We performed an independent component analysis (ICA) of the EMG data and removed crosstalk components. Speaking and chewing induced EMG activity in the masseter and suprahyoid muscles, as well as the zygomatic major muscle. The ICA-reconstructed EMG signals reduced the effects of speaking and chewing on zygomatic major activity, compared with the original signals. These data suggest that: (1) mouth actions could induce crosstalk in zygomatic major EMG signals, and (2) ICA can reduce the effects of such crosstalk.
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Affiliation(s)
- Wataru Sato
- Psychological Process Research Team, Guardian Robot Project, RIKEN, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto 619-0288, Japan
- Field Science Education and Research Center, Kyoto University, Oiwake-cho, Kitashirakawa, Kyoto 606-8502, Japan
| | - Takanori Kochiyama
- Brain Activity Imaging Center, ATR-Promotions, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto 619-0288, Japan
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Pan DR, Clark NW, Chiang H, Kahmke RR, Phillips BT, Barrett DM. The evolution of facial reanimation techniques. Am J Otolaryngol 2023; 44:103822. [PMID: 36934594 DOI: 10.1016/j.amjoto.2023.103822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.
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Affiliation(s)
- Debbie R Pan
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Nicholas W Clark
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Harry Chiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Russel R Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Brett T Phillips
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, NC, United States of America
| | - Dane M Barrett
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America.
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Hamed SA, Saad El-Din Mahmoud L, Magdy ElMeligie M, Zoheiry IM. Electrophysiological responses to Kabat motor control re-education on Bell's Palsy: A randomized controlled study. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2023; 23:90-97. [PMID: 36856104 PMCID: PMC9976179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVES to investigate the Electrophysiological responses post-Kabat Motor Control Re-education in Bell's palsy which might restore the neuromuscular circuit and normal function of the nerve. METHODS Thirty children diagnosed with Bell's palsy were equally divided into two groups; the study group that received Kabat Motor Control Re-education and the physical therapy selected designed program, and the control group that received physical therapy selected designed program. The outcomes included Electroneurography (ENoG) measuring distal latency, amplitude, and percentage of degenerations, and the Sunnybrook facial grading system (SFGS), as pre and post-treatment, all parameters were evaluated. RESULTS The ENoG findings approved that post-intervention there was a significant improvement in the study group more than the control group (p<0.05), as the percent of change of latency, amplitude, and percent of degeneration for both frontalis and orbicularis oris of the study group was 18.12-13.6%, 88.3-107.8%, and 74.4-78.9% respectively and that of the control group was 10.8-7.7%, 63.4-69.4%, and 54.9-54.8% respectively, also the percent of change of SFGS post-treatment, for study and control groups was 234.1% and 209.1% respectively. CONCLUSION The Electrophysiological responses approved that the advanced Kabat rehabilitation combined with motor control re-education training using extrinsic feedback cues had a valuable effect in the treatment of Bell's Palsy. CLINICAL TRIALS gov ID: NCT04894513.
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Affiliation(s)
- Somaia A Hamed
- Department of Physical Therapy for Pediatrics and woman health, Acting vice Dean of faculty of physical therapy, Ahram Canadian University, Egypt
| | - Lama Saad El-Din Mahmoud
- Department of Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, October 6 University, Egypt
| | | | - Ibrahim M Zoheiry
- Department of Physical Therapy for Surgery, Dean of Faculty of Physical Therapy, Al Hayah University, Egypt
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P P, Muthukrishnan A. Assessment of Nerve Conduction in Patients With Lower Motor Neuron Facial Paralysis. Cureus 2023; 15:e35422. [PMID: 36987490 PMCID: PMC10040237 DOI: 10.7759/cureus.35422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Bell's palsy (BP), a lower motor neuron facial paralysis, commonly causes dysfunction of muscles of facial expression. Nerve conduction electrodiagnostic studies differentiate early-stage minor conduction blocks from later-stage Wallerian degeneration. Nerve conduction studies (NCSs) assess facial nerve function by delivering supramaximal electrical stimulus at the stylomastoid foramen. The amplitude loss percentage of the affected side is calculated with reference to the normal side. Aim The study's aim was to characterize the ncs in BP cases and to evaluate the correlation between the Compound Muscle Action Potential (CMAP) of the muscles affected. Materials and methods One hundred and four NCS data of BP cases were retrospectively collected over the period of two years. Statistical analyses of variables were done using the Chi-square test, one-way ANOVA, and Pearson correlation coefficient. Result The greater amplitude loss was seen in the orbicularis oris muscle innervated by buccal and mandibular branches of the facial nerve. The bivariate correlation between the Right Nasalis versus Right Orbicularis Oculi and Left Orbicularis Oculi versus Left Nasalis showed a highly significant moderately Strong Positive Correlation with an R-value of 0.687 and 0.558, respectively. The amplitude drop percentage was statistically significant in the affected left and right sides with P values of 0.008 and 0.007 respectively (P value < 0.05). The amplitude drop between the nasalis, orbicularis oculi and orbicularis oris muscles of both sides was statistically significant with a P value of 0.001. Conclusion NCS should be mandatorily included as an assessment protocol in BP cases for quantification of nerve degeneration and as a prognostic tool during the course of treatment.
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Affiliation(s)
- Poornachitra P
- Oral Medicine and Radiology, Saveetha Dental College and Hospital, Chennai, IND
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24
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Zhao J, Zeng W, Qiu C, Liu J, Li K, Huang J, Tong MCF, Zhang X. Protection of the marginal mandibular branches of the facial nerves by different surgical procedures in comprehensive cervical lymphadenectomy for locally advanced oral and oropharyngeal cancer: a multicenter experience. World J Surg Oncol 2023; 21:30. [PMID: 36721264 PMCID: PMC9887872 DOI: 10.1186/s12957-023-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE According to the different characteristics of patients and cervical lymph node metastasis of oral and oropharyngeal cancer, the marginal mandibular branches of facial nerves were treated by different surgical procedures, and the safety and protective effects of different surgical procedures were investigated. METHODS One hundred ninety-seven patients with oral and oropharyngeal cancer satisfying the inclusion criteria were selected. According to the different characteristics of patients and cervical metastatic lymph nodes, three different surgical procedures were used to treat the marginal mandibular branches of the facial nerve: finding and exposing the marginal mandibular branches of the facial nerves at the mandibular angles of the platysma flaps, finding and exposing the marginal mandibular branches of facial nerves at the intersections of the distal ends of facial arteries and veins with the mandible, and not exposing the marginal mandibular branches of the facial nerves. The anatomical position, injury, and complications of the marginal mandibular branches of the facial nerves were observed. RESULTS The marginal mandibular branches of the facial nerves were found and exposed at the mandibular angles of the platysma flaps in 102 patients; the marginal mandibular branches of facial nerves were found and exposed at the intersections of the distal ends of the facial arteries and veins with the mandibles in 64 patients; the marginal mandibular branches of facial nerves were not exposed in 31 patients; among them, four patients had permanent injury of the marginal mandibular branches of the facial nerves, and temporary injury occurred in seven patients. There were statistically significant differences in the protection of the mandibular marginal branch of the facial nerve among the three different surgical methods (P = 0.0184). The best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap, and the injury rate was only 2.94%. CONCLUSION The three different surgical procedures were all safe and effective in treating the marginal mandibular branches of the facial nerves, the best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap.
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Affiliation(s)
- Jiuzhou Zhao
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Wen Zeng
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Chengyu Qiu
- Department of Oral and Maxillofacial Surgery, First Hospital of Qiqihaer City, Heilongjiang Province, Qiqihaer, People’s Republic of China
| | - Jiafeng Liu
- grid.452437.3Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province People’s Republic of China
| | - Ke Li
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Jing Huang
- Department of Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Michael C. F. Tong
- grid.10784.3a0000 0004 1937 0482Department of Otorhinolaryngology, Head & Neck Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China
| | - Xiangmin Zhang
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
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Volk GF, Döhler M, Klinger CM, Weiss T, Guntinas-Lichius O. Sensory function in the faces of patients with facial palsy: A prospective observational study using quantitative sensory testing. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1041905. [PMID: 36600906 PMCID: PMC9806347 DOI: 10.3389/fpain.2022.1041905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Objectives/Hypothesis To determine the sensory function of both sides of the face in patients with acute or chronic facial palsy. Study design Prospective observational study. Methods The standardized quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain (DFNS), including thermal or mechanical stimuli (touch, pain, vibration, and pressure), was used to investigate somatosensory function in the faces of patients. A patient-reported outcome measures for the assessment of disturbed facial comfort or facial pain, the facial Clinimetric Evaluation Scale (FaCE) Facial Comfort Subscale, and the 36-Item Short Form Survey (SF-36) pain subdomain were used. Results A total of 29 patients (22 female, median age of 48 years; 7 acute palsy; 22 chronic palsy; House-Brackmann grade II-VI) were included. The median FaCE Facial Comfort Subscale score and the median SF-36 pain subdomain score were 50 and 100, respectively. Most patients had, at an individual level, a normal sensory function in all or most tests. On average, the frequencies for all parameters were not different between the paretic side and the contralateral side (all p > 0.05). Additionally, when z-scores were used to compare our patient sample with healthy controls from the DFNS reference database, there was no difference between the paretic side and the contralateral side (all p > 0.05). Furthermore, there were no differences between patients with acute facial palsy and those with chronic facial palsy (all p > 0.05). The FaCE Facial Comfort Subscale score and the SF-36 pain subdomain score did not correlate with the QST parameters (all p > 0.05). Conclusion Patients with acute or chronic unilateral peripheral facial palsy had normal sensory function on the paretic and contralateral sides compared with the reference values of healthy controls, and there was no significant difference between the sides. The numbness frequently felt in the affected hemiface is not related to a peripheral sensory disorder and is most likely a manifestation of an unsolved cortical somatosensory-motor mismatch.
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Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Marianna Döhler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | | | - Thomas Weiss
- Department of Psychology, Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany,Correspondence: Orlando Guntinas-Lichius
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Mueller N, Trentzsch V, Grassme R, Guntinas-Lichius O, Volk GF, Anders C. High-resolution surface electromyographic activities of facial muscles during mimic movements in healthy adults: A prospective observational study. Front Hum Neurosci 2022; 16:1029415. [PMID: 36579128 PMCID: PMC9790991 DOI: 10.3389/fnhum.2022.1029415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives Surface electromyography (sEMG) is a standard tool in clinical routine and clinical or psychosocial experiments also including speech research and orthodontics to measure the activity of selected facial muscles to objectify facial movements during specific facial exercises or experiments with emotional expressions. Such muscle-specific approaches neglect that facial muscles act more as an interconnected network than as single facial muscles for specific movements. What is missing is an optimal sEMG setting allowing a synchronous measurement of the activity of all facial muscles as a whole. Methods A total of 36 healthy adult participants (53% women, 18-67 years) were included. Electromyograms were recorded from both sides of the face using an arrangement of electrodes oriented by the underlying topography of the facial muscles (Fridlund scheme) and simultaneously by a geometric and symmetrical arrangement on the face (Kuramoto scheme). The participants performed a standard set of different facial movement tasks. Linear mixed-effects models and adjustment for multiple comparisons were used to evaluate differences between the facial movement tasks, separately for both applied schemes. Data analysis utilized sEMG amplitudes and also their maximum-normalized values to account for amplitude differences between the different facial movements. Results Surface electromyography activation characteristics showed systematic regional distribution patterns of facial muscle activation for both schemes with very low interindividual variability. The statistical significance to discriminate between the different sEMG patterns was good for both schemes (significant comparisons for sEMG amplitudes: 87.3%, both schemes, normalized values: 90.9%, Fridlund scheme, 94.5% Kuramoto scheme), but the Kuramoto scheme performed considerably superior. Conclusion Facial movement tasks evoke specific patterns in the complex network of facial muscles rather than activating single muscles. A geometric and symmetrical sEMG recording from the entire face seems to allow more specific detection of facial muscle activity patterns during facial movement tasks. Such sEMG patterns should be explored in more clinical and psychological experiments in the future.
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Affiliation(s)
- Nadiya Mueller
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Vanessa Trentzsch
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Roland Grassme
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Prevention, Biomechanics, German Social Accident Insurance Institution for the Foodstuffs and Catering Industry, Erfurt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany,*Correspondence: Orlando Guntinas-Lichius,
| | - Gerd Fabian Volk
- Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Christoph Anders
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Lee DH, Kwon BI, Yu JS, Park SK, Kim JH. Neural mechanisms underlying peripheral facial nerve palsy: A protocol for systematic review and meta-analysis of neuroimaging studies. Medicine (Baltimore) 2022; 101:e32110. [PMID: 36482522 PMCID: PMC9726285 DOI: 10.1097/md.0000000000032110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral facial nerve palsy is a general term used to describe diseases that cause lower motor neuron lesions in the facial nerve. The most common cause of peripheral facial nerve palsy is idiopathic Bell's palsy (BP), accounting for 60% to 70% of all peripheral facial nerve palsy cases. Idiopathic BP is found in various medical conditions, such as ischemia, viral infection, and neuroinflammation; however, the specific pathophysiology remains unclear. Neuroimaging techniques help understand the neural mechanisms underlying various neurological disorders. In recent years, several studies have applied functional neuroimaging to investigate alterations of brain function in BP patients. However, the results have been inconsistent due to differences in methodology and quality. Moreover, systematic reviews of studies on functional neuroimaging for BP are insufficient. Therefore, the present study aims to verify the neural mechanisms of brain alterations and draw conclusions about the functional reorganization in patients with BP. METHODS This review includes all suitable studies published on or before October 31, 2022. A thorough search will be conducted using the following databases: MEDLINE, Cochrane Library, Excerpta Medica Database (EMBASE), China Knowledge Resource Integrated Database (CNKI), Korean Medical database (KMBASE), Korean Studies Information Service System (KISS). Clinical studies of BP using functional neuroimaging will be selected. We will apply a coordinate-based meta-analysis because most individual neuroimaging studies provide their results as coordinates in the standard space. The primary outcomes will include the types of functional neuroimaging methods and alterations of brain function in BP patients. The secondary outcomes will include the information about clinical measurement of the disease. Study selection, data extraction, and risk of bias assessment will be conducted. If possible, heterogeneity tests, data synthesis, and subgroup analyses will be conducted. RESULTS The study will analyze the alterations in brain activity and worsening of clinical symptoms caused by idiopathic BP. CONCLUSION The aim of this study is to investigate functional reorganization of brain alterations in patients with BP. This review will improve the understanding of the neural mechanisms of BP based on the most recent publications through extensive data retrieval. If sufficient data are collected, a sensitivity analysis is performed to verify the robustness of the conclusions.
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Affiliation(s)
- Dong Hyuk Lee
- Department of Anatomy, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
- Research institute of Korean medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
| | - Bo-In Kwon
- Research institute of Korean medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
- Department of Pathology, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
| | - Jun-Sang Yu
- Research institute of Korean medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
| | - Sang Kyun Park
- Department of Meridian & Acupoints, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
| | - Joo-Hee Kim
- Research institute of Korean medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, Wonju-si, Gangwon-do, Republic of Korea
- * Correspondence: Joo-Hee Kim, Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Sangji University, 83 Sangjidae-gil, Wonju-si, Gangwon-do 26339, Republic of Korea (e-mail: )
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Guntinas-Lichius O, Prengel J, Cohen O, Mäkitie AA, Vander Poorten V, Ronen O, Shaha A, Ferlito A. Pathogenesis, diagnosis and therapy of facial synkinesis: A systematic review and clinical practice recommendations by the international head and neck scientific group. Front Neurol 2022; 13:1019554. [PMID: 36438936 PMCID: PMC9682287 DOI: 10.3389/fneur.2022.1019554] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Post-paralytic facial synkinesis after facial nerve injury produces functional disabilities and mimetic deficits, but also cosmetic and non-motor psychosocial impairments for the patients. These patients typically have a high and continuous high motivation for rehabilitation. The aim is to inform the affected patients and their therapeutic professionals (otorhinolaryngologist - head and neck surgeons; oral-maxillofacial surgeons, plastic and reconstructive surgeons, neurosurgeons, neurologists, and mime therapists be it speech and language therapy- or physiotherapy-based) and to provide practical recommendations for diagnostics and a stepwise systematic treatment approach of facial synkinesis. Methods In the first phase, a systematic literature search on the topic in PubMed and ScienceDirect starting in 2008 resulted in 132 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostic tests and treatment options. In the second phase, one consensus article circulated among the membership of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. Results Diagnostics should include a standardized assessment of the degree of synkinesis using validated clinician-graded instruments and synkinesis-specific patient-reported outcome measures. Treatments for facial synkinesis include facial training mainly based on facial biofeedback retraining, chemodenervation with botulinum toxin, selective neurectomy, myectomy, and any combination treatment of these options. Conclusion A basic understanding of the pathomechanisms of synkinesis is essential to understand the treatment strategies. A standardized assessment of the synkinetic symptoms and the individual synkinesis pattern is needed. The first-line treatment is facial training, followed by botulinum toxin. Surgery is reserved for individual cases with unsatisfactory first-line treatment.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial Nerve Center, Jena University Hospital, Jena, Germany,Multidisciplinary Salivary Gland Society, Geneva, Switzerland,*Correspondence: Orlando Guntinas-Lichius
| | - Jonas Prengel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Affiliated With Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Vincent Vander Poorten
- Multidisciplinary Salivary Gland Society, Geneva, Switzerland,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium,Otorhinolaryngology, Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ohad Ronen
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Affiliated With Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ashok Shaha
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Pinto MMR, dos Santos DR, Bentes LGDB, Lemos RS, de Almeida NRC, Fernandes MRN, Braga JP, Somensi DN, de Barros RSM. Anatomical description of the extratemporal facial nerve under high-definition system: a microsurgical study in rats. Acta Cir Bras 2022; 37:e370803. [PMID: 36327397 PMCID: PMC9633007 DOI: 10.1590/acb370803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/25/2022] [Accepted: 07/22/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To describe the microsurgical anatomical aspects of the extratemporal facial nerve of Wistar rats under a high-definition video system. METHODS Ten male Wistar rats (12-15 weeks old), without veterinary diseases, weighing 220-280 g, were used in this study. All animals in this study were submitted to the same protocol and by the same surgeon. A 10-mm incision was made below the bony prominence of the right or left ear, and extended towards the angle of the mandible. The dissection was performed and the main branches of the facial nerve were dissected. RESULTS The main trunk of the facial nerve has a length of 0.88 ± 0.10 mm and a length of 3.81 ± 1.03 mm, measured from its emergence from the stylomastoid foramen to its bifurcation. Seven branches originating from the facial nerve were identified: posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic. CONCLUSIONS The anatomy of the facial nerve is comparable to that of humans, with some variations. The most observed anatomical division was the distribution in posterior auricular, posterior cervical, cervical, mandibular, buccal, temporal, and zygomatic branches. There is no statistical difference between the thickness and distance of the structures compared to the contralateral side.
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Affiliation(s)
- Marcela Maria Rabelo Pinto
- MD, Fellow Master Degree. Universidade do Estado do Pará – Postgraduate Program in Surgery and Experimental Research Medicine – Department of Experimental Surgery – Belem (PA), Brazil
| | - Deivid Ramos dos Santos
- MD, Fellow Master Degree. Universidade do Estado do Pará – Postgraduate Program in Surgery and Experimental Research Medicine – Department of Experimental Surgery – Belem (PA), Brazil
| | | | - Rafael Silva Lemos
- Graduate student. Universidade do Estado do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
| | | | | | - Joyce Pantoja Braga
- Graduate student. Universidade Federal do Pará – School of Medicine – Department of Experimental Surgery - Belém (PA), Brazil
| | - Danusa Neves Somensi
- MD. Universidade Federal do Pará – School of Medicine – Department of Neurology – Belém (PA), Brazil
| | - Rui Sergio Monteiro de Barros
- PhD, Associate Professor. Universidade Federal do Pará – School of Medicine – Department of Experimental Surgery – Belém (PA), Brazil
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Facial Emotion Recognition in Patients with Post-Paralytic Facial Synkinesis—A Present Competence. Diagnostics (Basel) 2022; 12:diagnostics12051138. [PMID: 35626294 PMCID: PMC9139660 DOI: 10.3390/diagnostics12051138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Facial palsy is a movement disorder with impacts on verbal and nonverbal communication. The aim of this study is to investigate the effects of post-paralytic facial synkinesis on facial emotion recognition. In a prospective cross-sectional study, we compared facial emotion recognition between n = 30 patients with post-paralytic facial synkinesis (mean disease time: 1581 ± 1237 days) and n = 30 healthy controls matched in sex, age, and education level. Facial emotion recognition was measured by the Myfacetraining Program. As an intra-individual control condition, auditory emotion recognition was assessed via Montreal Affective Voices. Moreover, self-assessed emotion recognition was studied with questionnaires. In facial as well as auditory emotion recognition, on average, there was no significant difference between patients and healthy controls. The outcomes of the measurements as well as the self-reports were comparable between patients and healthy controls. In contrast to previous studies in patients with peripheral and central facial palsy, these results indicate unimpaired ability for facial emotion recognition. Only in single patients with pronounced facial asymmetry and severe facial synkinesis was an impaired facial and auditory emotion recognition detected. Further studies should compare emotion recognition in patients with pronounced facial asymmetry in acute and chronic peripheral paralysis and central and peripheral facial palsy.
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Kurz A, Volk GF, Arnold D, Schneider-Stickler B, Mayr W, Guntinas-Lichius O. Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis. Front Neurol 2022; 13:869900. [PMID: 35444611 PMCID: PMC9013944 DOI: 10.3389/fneur.2022.869900] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022] Open
Abstract
This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions. The focus is on electrical stimulation in the phase between denervation and reinnervation of the target muscles. The aim of electrostimulation in this phase of denervation is to bridge the time until reinnervation is complete and to maintain facial or laryngeal function. In this phase, electrostimulation has to stimulate directly the denervated muscles, i.e. muscle stimulation and not nerve stimulation. There is preliminary data that early electrostimulation might also improve the functional outcome. Because there are still caveats against the use of electrostimulation, the neurophysiology of denervated facial and laryngeal muscles in comparison to innervated muscles is explained in detail. This is necessary to understand why the negative results published in several studies that used stimulation parameters are not suitable for denervated muscle fibers. Juxtaposed are studies using parameters adapted for the stimulation of denervated facial or laryngeal muscles. These studies used standardized outcome measure and show that an effective and tolerable electrostimulation of facial and laryngeal muscles without side effects in the early phase after onset of the lesions is feasible, does not hinder nerve regeneration and might even be able to improve the functional outcome. This has now to be proven in larger controlled trials. In our view, surface electrical stimulation has an unexploited potential to enrich the early therapy concepts for patients with unilateral facial or vocal fold paralysis.
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Affiliation(s)
- Annabella Kurz
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Berit Schneider-Stickler
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
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Prospective Assessment of Intraoperative Facial Nerve Monitoring in Patients Undergoing Partial Parotidectomy. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3318175. [PMID: 35360516 PMCID: PMC8964167 DOI: 10.1155/2022/3318175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/31/2022] [Accepted: 02/26/2022] [Indexed: 11/18/2022]
Abstract
The most significant complication of parotid gland tumor surgery is facial weakness. This study compares the occurrence of transient facial palsy in patients with parotid gland tumors who underwent surgery without monitoring to those who underwent surgery with monitoring. The study’s aim was to investigate facial nerve function in patients undergoing parotidectomy as well as the effect of intraoperative facial nerve monitoring and the effect of certain risk factors on the surgery and onset of postoperative facial palsy. This prospective study included 100 patients who underwent parotidectomy. The study cohort was divided into two groups. Group I included 50 patients who underwent surgery without neuromonitoring and group II included 50 patients who underwent surgery with neuromonitoring. The neurological assessment was conducted using the House–Brackmann scale. Preoperatively and one month postoperatively, electroneuronography (ENoG) and blink reflex tests were done. The analyses showed a significant reduction of the compound muscle action potential (CMAP) amplitude of the orbicularis oculi and orbicularis oris muscles and prolonged R1 and R2 blink reflex latencies 1 month after surgery. On neurological and electrophysiological studies, the rate of postoperative transient facial nerve dysfunction was significantly different between the groups. Significantly more patients, operated with use of facial nerve monitoring, presented postoperatively normal nerve function (i.e., House–Brackmann grade I) compared to those who underwent surgery without monitoring (78% and 26%, respectively;
). Monitoring had a statistically significant impact on the prevalence of facial nerve conduction disorders in patients who underwent surgery, according to the blink reflex and ENoG studies. The duration of the surgical procedure was not affected by monitoring in any way. The clinical evaluation of facial nerve function (House–Brackmann scale) and some ENoG results 1 month after surgery were found to have a significant correlation. To summarize, using monitoring considerably reduced the negative impact of local factors and the prevalence of transient facial nerve palsy.
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Thielker J, Kouka M, Guntinas-Lichius O. [Preservation, reconstruction, and rehabilitation of the facial nerve]. HNO 2022; 71:232-242. [PMID: 35288765 PMCID: PMC8920054 DOI: 10.1007/s00106-022-01148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
Der Umgang mit dem N. facialis ist bei der Operation eines Parotiskarzinoms wichtig für die Langzeitlebensqualität des Patienten. In etwa 2 Drittel der Fälle ist der N. facialis nicht vom Tumor befallen. In diesen Fällen sind neben vollständiger Tumorentfernung die Identifizierung und der Erhalt des Nervs für eine erfolgreiche Operation wesentlich. Ist der Nerv vom Tumor infiltriert, muss der betroffene Teil des Nervs im Rahmen einer radikalen Parotidektomie reseziert werden. Die primäre Nervenrekonstruktion, sofern möglich, führt zu den besten funktionellen und kosmetischen Langzeitergebnissen. Das individuell optimale Therapiekonzept basiert zum einen auf der klinischen Prüfung der Gesichtsbeweglichkeit, zum anderen auf der präoperativen Bildgebung, um die Lagebeziehung zwischen Tumor und Nerv zu verstehen, und schließlich auf einer elektrophysiologischen Untersuchung zur Funktion des Nervs. Intraoperativ hilft ein standardisiertes Vorgehen, um den Nerv zu identifizieren und zu erhalten. Wenn eine radikale Parotidektomie indiziert ist, kann bereits die präoperative Diagnostik helfen, neben der einzeitigen Rekonstruktion auch die adjuvante postoperative Therapie zu planen. Das Ziel der Rehabilitation ist die Wiederherstellung von Tonus, Symmetrie und Bewegung des gelähmten Gesichts. Die Wiederherstellung des Augenschlusses hat hohe Priorität. Bei der chirurgischen Therapie von Gesichtslähmungen gab es in den letzten Jahren viele Verbesserungen. Die vorliegende Arbeit gibt einen Überblick über die jüngsten Fortschritte in der Diagnostik, den Operationstechniken und weiteren Möglichkeiten zur Protektion des gesunden N. facialis. Anderseits wird die Rehabilitation des tumorinfiltrierten N. facialis im Kontext der Behandlung von Speicheldrüsenmalignomen beschrieben.
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Affiliation(s)
- Jovanna Thielker
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland
| | - Mussab Kouka
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland
| | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland. .,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland.
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Elkahwagi M, Salem MA, Moneir W, Allam H. Traumatic facial nerve paralysis dilemma. Decision making and the novel role of endoscope. J Otol 2022; 17:116-122. [PMID: 35847576 PMCID: PMC9270561 DOI: 10.1016/j.joto.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The management of traumatic facial nerve paralysis (FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management. However, recent advances in endoscopic surgery may consolidate the management plan for this condition. Methods This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach (TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group. Outcome The main outcome was facial function improvement, assessed using the House Brackmann grading scale (HBGS) 6 months after surgery, and hearing state assessed using the air bone gap (ABG). Results The study included 38 patients, of whom 15 underwent had surgical decompression and 23 underwent conservative therapy. A significant improvement in facial nerve function from a mean of 4.66 ± 0.97 to 1.71 ± 0.69 (P = 0.001) and ABG from a median of 30 (10–40) to 20 (10–25) (P = 0.002) was observed. Conclusion Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.
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Multidisciplinary Care of Patients with Facial Palsy: Treatment of 1220 Patients in a German Facial Nerve Center. J Clin Med 2022; 11:jcm11020427. [PMID: 35054119 PMCID: PMC8778429 DOI: 10.3390/jcm11020427] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures (p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE (p < 0.001). Upper eyelid weight (3.8%) and hypoglossal–facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function (p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy.
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Rüschenschmidt H, Volk GF, Anders C, Guntinas-Lichius O. Electromyography of Extrinsic and Intrinsic Ear Muscles in Healthy Probands and Patients with Unilateral Postparalytic Facial Synkinesis. Diagnostics (Basel) 2022; 12:diagnostics12010121. [PMID: 35054288 PMCID: PMC8775077 DOI: 10.3390/diagnostics12010121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 11/16/2022] Open
Abstract
There are currently no data on the electromyography (EMG) of all intrinsic and extrinsic ear muscles. The aim of this work was to develop a standardized protocol for a reliable surface EMG examination of all nine ear muscles in twelve healthy participants. The protocol was then applied in seven patients with unilateral postparalytic facial synkinesis. Based on anatomic preparations of all ear muscles on two cadavers, hot spots for the needle EMG of each individual muscle were defined. Needle and surface EMG were performed in one healthy participant; facial movements could be defined for the reliable activation of individual ear muscles’ surface EMG. In healthy participants, most tasks led to the activation of several ear muscles without any side difference. The greatest EMG activity was seen when smiling. Ipsilateral and contralateral gaze were the only movements resulting in very distinct activation of the transversus auriculae and obliquus auriculae muscles. In patients with facial synkinesis, ear muscles’ EMG activation was stronger on the postparalytic compared to the contralateral side for most tasks. Additionally, synkinetic activation was verifiable in the ear muscles. The surface EMG of all ear muscles is reliably feasible during distinct facial tasks, and ear muscle EMG enriches facial electrodiagnostics.
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Affiliation(s)
- Hanna Rüschenschmidt
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (H.R.); (G.F.V.)
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (H.R.); (G.F.V.)
- Facial Nerve Center, Jena University Hospital, 07747 Jena, Germany
- Center for Rare Diseases, Jena University Hospital, 07747 Jena, Germany
| | - Christoph Anders
- Division for Motor Research, Pathophysiology and Biomechanics, Department for Trauma-, Hand- and Reconstructive Surgery, Jena University Hospital, 07743 Jena, Germany;
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, 07747 Jena, Germany; (H.R.); (G.F.V.)
- Facial Nerve Center, Jena University Hospital, 07747 Jena, Germany
- Center for Rare Diseases, Jena University Hospital, 07747 Jena, Germany
- Correspondence: ; Tel.: +49-364-1932-9301; Fax: +49-364-1932-9302
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The Offprint of an Abnormal Pre-Parotidectomy Electrodiagnostic Finding in a Normally Functioning Facial Nerve: Correlation with Intraoperative Findings, Histology and Postoperative Facial Nerve Function. J Clin Med 2022; 11:jcm11010248. [PMID: 35011988 PMCID: PMC8746093 DOI: 10.3390/jcm11010248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to search for associations between an electrodiagnostically abnormal but clinically normal facial nerve before parotidectomy and the intraoperative findings, as well as the postoperative facial nerve function. The records of all patients treated for parotid tumors between 2002 and 2021 with a preoperative House–Brackmann score of grade I but an abnormal electrophysiologic finding were studied retrospectively. A total of 285 patients were included in this study, and 222 patients had a benign lesion (77.9%), whereas 63 cases had a malignant tumor (22.1%). Electroneurographic facial nerve involvement was associated with nerve displacement in 185 cases (64.9%) and infiltration in 17 cases (6%). In 83 cases (29.1%), no tumor–nerve interface could be detected intraoperatively. An electroneurographic signal was absent despite supramaximal stimulation in 6/17 cases with nerve infiltration and in 17/268 cases without nerve infiltration (p < 0.001). The electrophysiologic involvement of a normal facial nerve is not pathognomonic for a malignancy (22%), but it presents a rather rare (~6%) sign of a “true” nerve infiltration and could also appear in tumors without any contact with the facial nerve (~29%). Of our cases, two thirds of those with an anatomic nerve preservation and facial palsy had already directly and postoperatively recovered to a major extent in the midterm.
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Bilge S, Mert GG, Hergüner MÖ, İncecik F, Sürmelioğlu Ö, Bilen S, Yılmaz L. Peripheral facial nerve palsy in children: clinical manifestations, treatment and prognosis. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:152. [PMCID: PMC9734354 DOI: 10.1186/s41983-022-00596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background Sudden onset of unilateral weakness of the upper and lower muscles of one side of the face is defined as peripheral facial nerve palsy. Peripheral facial nerve palsy is often idiopathic and sometimes it could be due to infectious, traumatic, neoplastic, and immune causes. This study aimed to report the clinical manifestation, evaluation, and prognosis in children with peripheral facial nerve palsy. Methods 57 children under 18 years of age diagnosed with peripheral facial nerve palsy at Çukurova University, Balcalı Hospital, between January 2018 and September 2021, were included in the study. Results The mean age of the children at the time of diagnosis was 9.6 ± 7, 4 years. Thirty-two (56.1%) of the patients were female and 25 (43.9%) were male. A total of 57 patients were diagnosed with peripheral facial nerve palsy and categorized into many groups by etiology: idiopathic Bell’s palsy in 27 (47.5%), infectious in 11 (19.2%), traumatic in 6 (10.5%), and others (due to congenital, immune, neoplastic, Melkersson–Rosenthal syndrome, drug toxicity, and iatrogenic causes) in 13 (22.8%). Forty-six of the children achieved full recovery under oral steroids within 1–7 months. Four patients with acute leukemia, myelodysplastic syndrome, Mobius syndrome and trauma did not recover and two patients (schwannoma, trauma) showed partial improvement. Five patients could not come to follow-up control. Conclusion Peripheral facial nerve palsy is a rare condition in children with different causes. It could be idiopathic, congenital, or due to infectious, traumatic, neoplastic, and immune reasons. So, when a child presents with facial palsy, a complete clinical history and a detailed clinical examination are recommended. Giving attention to the red flag is very important. Peripheral facial nerve palsy in children is considered to have a good prognosis.
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Affiliation(s)
- Serap Bilge
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Gülen Gül Mert
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - M. Özlem Hergüner
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Faruk İncecik
- grid.98622.370000 0001 2271 3229Department of Pediatric Neurology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Özgür Sürmelioğlu
- grid.98622.370000 0001 2271 3229Department of Ear, Nose &Throat, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sevcan Bilen
- grid.98622.370000 0001 2271 3229Department of Pediatric Emergency, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Levent Yılmaz
- grid.98622.370000 0001 2271 3229Department of Pediatric Emergency, Faculty of Medicine, Çukurova University, Adana, Turkey
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Osthues M, Kuttenreich AM, Volk GF, Dobel C, Strauss B, Altmann U, Guntinas-Lichius O. Continual rehabilitation motivation of patients with postparalytic facial nerve syndrome. Eur Arch Otorhinolaryngol 2022; 279:481-491. [PMID: 34027598 PMCID: PMC8141409 DOI: 10.1007/s00405-021-06895-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the continued rehabilitation motivation in patients with postparalytic facial synkinesis (PFS). METHODS In this single-center cross-sectional survey, the multidimensional patient questionnaire for assessment of rehabilitation motivation (PAREMO-20) was used to assess the rehabilitation motivation. Associations Sunnybrook and Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, general quality of life (SF-36), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire (PHQ)-9, technology commitment and affinity, and interest in further therapy were analyzed. RESULTS 69 adults with PFS (73% women; median age: 54 years) answered the survey. In comparison to prior treatment forms, there was a significant higher future interest in computer-based home facial training (p < 0.0001). For PAREMO Psychological burden subscore, SF36 Emotional role was the highest negative correlative factor (p < 0.0001). For PAREMO Physical burden subscore, SF-36 General health was the highest negative correlative factor (p = 0.018). Working (p = 0.033) and permanent relationship (p = 0.029) were the only independent factors correlated to PAREMO Social Support Subscore. Higher positive impacts of technology affinity was inversely correlated to PAREMO Knowledge subscore (p = 0.017). Lower SF-36 Role physical subscore p = 0.045) and a lower SF-36 General health (p = 0.013) were correlated to a higher PAREMO Skepticism subscore. CONCLUSIONS Patients with PFS seem to have a high facial motor and non-motor psychosocial impairment even after several facial therapies. Rehabilitation-related motivation increases with both, higher facial motor and non-motor dysfunction. Social and emotional dysfunction are drivers to be interested in innovative digital therapy forms.
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Affiliation(s)
- Maike Osthues
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Anna-Maria Kuttenreich
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial Nerve Center Jena, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial Nerve Center Jena, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Facial Nerve Center Jena, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, Jena University Hospital, Jena, Germany
| | - Uwe Altmann
- Institute of Psychosocial Medicine, Psychotherapy and Psycho-Oncology, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Facial Nerve Center Jena, Jena University Hospital, Friedrich-Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Savytska IB. Clinical case of peripheral facial palsy as first and single COVID-19 symptom in an immunized patient. 18 2021. [DOI: 10.26565/2312-5675-2021-18-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
SARS-CoV-2 virus affects the central as well as the peripheral nervous system. Peripheral facial palsy is possible as the first and single COVID-19 symptom. The author presents own clinical observation of a 58-year-old patient with peripheral facial palsy. It is known that the patient completed the vaccination 8 weeks ago and also had direct contact with the patient SARS-CoV-2 (the patient's son). Facial nerve palsy was the first and only symptom of coronavirus infection. In the blood there was a moderate lymphocytopenia, increased interleukin-6, C-reactive protein, seromukoids. MRI of the brain and CT of the temporal bones did not reveal focal and diffuse pathology. After treatment, there was a complete recovery on the ninth day of treatment. Treatment included antiviral drugs, vitamins, steroids, kinesiotaping of facial muscles. The author substantiates necessity and demonstrates the results of treatment with endothelioprotective therapy (combination of L-arginine and L-carnitine) , which is aimed at elimination of systemic inflammation, oxidative stress caused by SARS-CoV-2 virus.
Conclusions. General practitioner need to be alert when examining patients, including those who have been vaccinated and those who have direct contact with patients with coronavirus infection. Pathogenesis of peripheral facial palsy in COVID-19 multidirectional: neuroinvasive and neurotropic effect of the virus on the nerve, hypercoagulation, ischemia of the peripheral nerve on the background of systemic inflammatory reaction, oxidative stress. Timely detection, careful monitoring and adequate treatment of pathology are necessary to prevent complications (persistent facial contractures, synkinesis). Further in-depth studies are needed on a larger sample of patients to identify the incidence of peripheral facial nerve palsy in COVID-19 and the possibility of a link to vaccination.
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Thielker J, Kuttenreich AM, Volk GF, Guntinas-Lichius O. [Diagnostics and Therapy of Idiopathic Facial Palsy (Bell's Palsy)]. Laryngorhinootologie 2021; 100:1004-1018. [PMID: 34826861 DOI: 10.1055/a-1529-3582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this review is to report the knowledge for otolaryngologists on standard of care, latest advances, interesting new findings and controversies about the treatment of Bell's palsy. This review is focusing on the acute phase of the disease. The chronic phase, with incomplete, incorrect or no recovery of the palsy, is described briefly. Treatment with prednisolone alone within 72 hours after onset still is the cornerstone of the treatment. The role of antivirals still is unclear. Since 2009 no new and breakthrough clinical trials with influence on the treatment standards have been performed. A study to clarify the role of prednisolone treatment in children is ongoing. Patient-related outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability Index are important tools to assess the subjective severity of the disease and psychosocial impact of Bell's palsy next to the motor deficits. Simplified subjective electronic grading systems like the eFACE and first automated image analysis systems have been introduced. Studies clarifying the role of antivirals for severe cases are urgently needed as well as studies on the role of salvage second line therapy after insufficient response to initial corticosteroid treatment. An international consensus on the outcome measures in diagnostics and follow-up is also needed.
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Affiliation(s)
| | | | | | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Jena, Germany
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Volk GF, Roediger B, Geißler K, Kuttenreich AM, Klingner CM, Dobel C, Guntinas-Lichius O. Effect of an Intensified Combined Electromyography and Visual Feedback Training on Facial Grading in Patients With Post-paralytic Facial Synkinesis. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:746188. [PMID: 36188835 PMCID: PMC9397686 DOI: 10.3389/fresc.2021.746188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/21/2021] [Indexed: 01/18/2023]
Abstract
Background: There is no current standard for facial synkinesis rehabilitation programs. The benefit and stability of effect of an intensified 10-day facial training combining electromyography and visual biofeedback training was evaluated. Methods: Fifty-four patients (77.8% female; median age: 49.5 years) with post-paralytic facial synkinesis (median time to onset of paralysis: 31.1 months) were included in retrospective longitudinal study between January 2013 and June 2016. Facial function was assesses at baseline (T0), first days of training (T1), last day of training (T2), and follow-up visit (T3) at a median time of 6 months later using the House-Brackmann (HB) facial nerve grading system, Stennert index (SI), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SFGS). Pairwise comparisons between the time points with post-hoc Bonferroni correction were performed. Results: No significant changes of the gradings and subscores were seen between T0 and T1 (all p > 0.01). The 10-day combined and intensified feedback training between T1 and T2 improved facial symmetry and decreased synkinetic activity. Facial grading with the FNGS 2.0 or the SFGS were most suited to depict the training effect. FNGS 2.0, regional score, FNGS 2.0, synkinesis score, and FNGS 2.0 total score improved significantly (all p ≤ 0.0001). Both, the FNGS 2.0 and the SFGS showed the strongest improvement in the nasolabial fold/zygomatic and the oral region. Neither the age of the patient (r = 0.168; p = 0.224), the gender (r = 0.126; p = 0.363) nor the length of the interval between onset of the palsy and training start (r = 0.011; p = 0.886) correlated with the changes of the SFGS between T1 and T2. The results remained stable between T2 and T3 without any further significant change. Conclusion: Intensified daily combined electromyography and visual biofeedback training over 10 days was effective in patients with facial synkinesis and benefits were stable 6 months after therapy.
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Affiliation(s)
- Gerd F. Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Benjamin Roediger
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Anna-Maria Kuttenreich
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Carsten M. Klingner
- Facial Nerve Center, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
- *Correspondence: Orlando Guntinas-Lichius
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Comparative Review of the Correlation Between Electroneurography, Electromyography, Hematology Tests, or the Heart Rate Variability Test, with an Improvement in the Severity of Bell’s Palsy Symptoms. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2021.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: In this retrospective study, we aimed to determine which diagnostic tests were associated with an improvement in Bell’s palsy symptoms. Methods: There were 30 patients who visited Kyung Hee University Korean Medicine Hospital from April 1, 2017 to February 29, 2020, and who received East-West collaboration treatment for Bell’s palsy. The tests included electroneurography (ENoG), electromyography (EMG), hematology, and heart rate variability (HRV) results which were used to determine if any test correlated with improvement of Bell’s palsy symptoms. Results: The initial severity of symptoms did not correlate with the tests performed, with the exception of mean corpuscular hemoglobin concentration (p = 0.013). For both ENoG for oculi degeneration and mean EMG tests, the rate of nerve degeneration showed a significant negative correlation with the improvement of Bell’s palsy symptoms. Amongst the HRV test indicators, the square root of the mean of the sum of the squares of differences between the adjacent normal R-R wave interval, the standard deviation of intervals, total power, very low frequency, and high frequency of the wave was negatively correlated with improvement of Bell’s palsy symptoms. Similarly, glycosylated hemoglobin Type A1c (HbA1c) and erythrocyte sedimentation rate (ESR) showed a negative correlation with improvement of symptoms of Bell’s palsy. With the exception of HbA1c and ESR, the remaining hematology test results showed no significant difference when comparing before and after treatment. Conclusion: ENoG, EMG, HRV test, HbA1c, and ESR negatively correlated with improvements in Bell’s palsy symptoms and may determine the prognosis of Bell’s palsy.
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Effectiveness of Surgical Treatment in Traumatic Facial Paralysis. J Craniofac Surg 2021; 33:750-753. [PMID: 34334751 DOI: 10.1097/scs.0000000000007977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION In the etiology of facial nerve palsy, trauma is the most important. Our aim was to present our experience gained by evaluating the surgical approaches we have used in extratemporal and intratemporal facial nerve injuries and their long-term results, also to contribute to the consensus that will be formed on this subject. MATERIALS AND METHODS Thirteen patients among 24 patients who underwent surgery with a diagnosis of traumatic facial paralysis were evaluated in this study. The clinical response of these patients to treatment was examined by classifying them according to the House-Brackmann classification in the preoperative and postoperative periods. RESULTS Of the 13 patients, 9 had fractures due to temporal bone trauma, and 4 had nerve damage in the extratemporal part of the facial nerve. In the treatment, facial nerve decompression was performed using the middle fossa approach in 9 patients with temporal bone fractures. In the 4 patients with extratemporal facial nerve injury, graft repair or primary suturing was performed. In the postoperative period, the stages of the patients were III or below in 12 patients (92%), and only 1 (8%) patient remained in stage IV. DISCUSSION When the postop conditions of the patients were examined according to House-Brackmann staging, it was observed that surgical treatment caused a significant improvement in the functions of the facial nerve. CONCLUSIONS Our results showed that surgery was an effective treatment method in patients with indications for traumatic facial paralysis.
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Schumann NP, Bongers K, Scholle HC, Guntinas-Lichius O. Atlas of voluntary facial muscle activation: Visualization of surface electromyographic activities of facial muscles during mimic exercises. PLoS One 2021; 16:e0254932. [PMID: 34280246 PMCID: PMC8289121 DOI: 10.1371/journal.pone.0254932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022] Open
Abstract
Complex facial muscle movements are essential for many motoric and emotional functions. Facial muscles are unique in the musculoskeletal system as they are interwoven, so that the contraction of one muscle influences the contractility characteristic of other mimic muscles. The facial muscles act more as a whole than as single facial muscle movements. The standard for clinical and psychosocial experiments to detect these complex interactions is surface electromyography (sEMG). What is missing, is an atlas showing which facial muscles are activated during specific tasks. Based on high-resolution sEMG data of 10 facial muscles of both sides of the face simultaneously recorded during 29 different facial muscle tasks, an atlas visualizing voluntary facial muscle activation was developed. For each task, the mean normalized EMG amplitudes of the examined facial muscles were visualized by colors. The colors were spread between the lowest and highest EMG activity. Gray shades represent no to very low EMG activities, light and dark brown shades represent low to medium EMG activities and red shades represent high to very high EMG activities relatively with respect to each task. The present atlas should become a helpful tool to design sEMG experiments not only for clinical trials and psychological experiments, but also for speech therapy and orofacial rehabilitation studies.
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Affiliation(s)
- Nikolaus P. Schumann
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Kevin Bongers
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Hans C. Scholle
- Division Motor Research, Pathophysiology and Biomechanics, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otolaryngology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- * E-mail:
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Hemihypoglossal-facial nerve anastomosis: results and electromyographic characterization. Eur Arch Otorhinolaryngol 2021; 279:467-479. [PMID: 34036422 DOI: 10.1007/s00405-021-06893-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The facial nerve surgery belongs to the basic procedures during lateral skull base approaches. Its damage has serious medical and psychological consequences, and therefore mastery of reconstruction and correction techniques should belong to the repertoire of skull base surgeons. The goal of this study was to demonstrate usefulness of electromyographic follow-up in facial nerve reconstruction. MATERIAL AND METHODS A total of 16 patients underwent hemihypoglossal-facial anastomosis between 2005 and 2017. Most of the primary lesions came from vestibular schwannoma surgery. All patients were examined with electromyography and scored according to the House-Brackmann and IOWA grading scales. Function of the tongue has been evaluated. RESULTS Ten patients achieved definitive House-Brackmann grade 3 score (62.5%). We did not observe any association with the patient's age, previous irradiation and the etiology of the damage. Electromyography showed pathological spontaneous activity after the first surgery. Incipient regeneration potentials were detected in 4-17 months (average 7.6) and reached maximum in 6.5-18 months (average 16). Electromyographic assessment of the effect of tongue movement showed better mimic voluntary activity by swallowing or by moving the tongue up. There was no relationship between the start of activity and the interval to achieving maximal activity. CONCLUSION Hemihypoglossal-facial nerve anastomosis is a safe procedure and it is an optimal solution for cases lacking a proximal stump or in the case of reconstruction in the second stage. Electromyography can predict initial reinnervation activity after reconstructive procedures. During subsequent follow-up it can help to discover insufficiently recovering patients, however clinical characteristics are crucial.
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Advanced Statistical Analysis of 3D Kinect Data: A Comparison of the Classification Methods. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper focuses on the statistical analysis of mimetic muscle rehabilitation after head and neck surgery causing facial paresis in patients after head and neck surgery. Our work deals with an evaluation problem of mimetic muscle rehabilitation that is observed by a Kinect stereo-vision camera. After a specific brain surgery, patients are often affected by face palsy, and rehabilitation to renew mimetic muscle innervation takes several months. It is important to be able to observe the rehabilitation process in an objective way. The most commonly used House–Brackmann (HB) scale is based on the clinician’s subjective opinion. This paper compares different methods of supervised learning classification that should be independent of the clinician’s opinion. We compare a parametric model (based on logistic regression), non-parametric model (based on random forests), and neural networks. The classification problem that we have studied combines a limited dataset (it contains only 122 measurements of 93 patients) of complex observations (each measurement consists of a collection of time curves) with an ordinal response variable. To balance the frequencies of the considered classes in our data set, we reclassified the samples from HB4 to HB3 and HB5 to HB6—it means that only four HB grades are used for classification algorithm. The parametric statistical model was found to be the most suitable thanks to its stability, tractability, and reasonable performance in terms of both accuracy and precision.
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Variants and Modifications of the Retroauricular Approach Using in Temporomandibular Joint Surgery: A Systematic Review. J Clin Med 2021; 10:jcm10102049. [PMID: 34064639 PMCID: PMC8151411 DOI: 10.3390/jcm10102049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction: The retroauricular approach (RA) has been developed in order to expose the temporomandibular joint in a way that minimizes the risk of injury to the facial nerve and masks the postoperative scar. One of its characteristics is an excellent posterolateral view of the mandibular head, which allows for the preservation of the lateral temporomandibular joint ligaments in the course of open intracapsular surgery. Aim: The aim of this study is to systematically review the currently used variants and modifications of RA. Materials and Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was performed based on the PubMed and BASE search engines; furthermore the authors performed a more detailed search in the Google Scholar article database as well as a loop search within the references of papers included in the systematic review. Results: Searching medical articles databases, Google Scholar, and references yielded a total of 85 records. First the titles and abstracts were blindly screened which was followed by a full-text eligibility check resulting in eventually including and qualifying 7 articles for detailed analysis. Discussion: All known variants and modifications of RA are characterized by high safety for the facial nerve and an aesthetically hidden scar. There were no reports of auricle necrosis in the collected material. Conclusions: In this systematic review, 2 variants and 2 modifications of RA that allow for open temporomandibular joint surgery have been identified; all of them together cover a large spectrum of indications for joint surgery, including reposition and osteosynthesis of mandibular head fractures, eminoplasty, or eminectomy and treatment of some forms of ankylosis.
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Lee SA, Jo SW, Chang SK, Kwon KH. Improvement of the Diagnostic Performance of Facial Neuritis Using Contrast-Enhanced 3D T1 Black-Blood Imaging: Comparison with Contrast-Enhanced 3D T1-Spoiled Gradient-Echo Imaging. J Clin Med 2021; 10:jcm10091850. [PMID: 33923134 PMCID: PMC8141108 DOI: 10.3390/jcm10091850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate the diagnostic ability of the contrast-enhanced 3D T1 black-blood fast spin-echo (T1 BB-FSE) sequence compared with the contrast-enhanced 3D T1-spoiled gradient-echo (CE-GRE) sequence in patients with facial neuritis. Forty-five patients with facial neuritis who underwent temporal bone MR imaging, including T1 BB-FSE and CE-GRE imaging, were examined. Two reviewers independently assessed the T1 BB-FSE and CE-GRE images in terms of diagnostic performance, and qualitative (diagnostic confidence and visual asymmetric enhancement) and quantitative analysis (contrast-enhancing lesion extent of the canalicular segment of the affected facial nerve (LEC) and the affected side-to-normal signal intensity ratio (rSI)). The AUCs of each reviewer, and the sensitivity and accuracy of T1 BB-FSE were significantly superior to those of CE-GRE (p < 0.05). Regarding diagnostic confidence and visual asymmetric enhancement, T1 BB-FSE tended to be rated greater than CE-GRE (p < 0.05). Additionally, in quantitative analysis, LEC and rSI of the canalicular segment on T1 BB-FSE were larger than those on CE-GRE (p < 0.05). The T1 BB-FSE sequence was significantly superior to the CE-GRE sequence, with more conspicuous lesion visualization in terms of both qualitative and quantitative aspects in patients with facial neuritis.
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Affiliation(s)
- Seun-Ah Lee
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea; (S.-A.L.); (S.-K.C.)
| | - Sang-Won Jo
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea; (S.-A.L.); (S.-K.C.)
- Correspondence: ; Tel.: +82-032-8086-2588
| | - Suk-Ki Chang
- Department of Radiology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea; (S.-A.L.); (S.-K.C.)
| | - Ki-Han Kwon
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, 7, Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Korea;
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Inagaki A, Katsumi S, Sekiya S, Murakami S. Intratympanic steroid therapy for Bell's palsy with poor prognostic results. Sci Rep 2021; 11:8058. [PMID: 33850231 PMCID: PMC8044212 DOI: 10.1038/s41598-021-87551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
In Bell's palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient's prognosis. The therapeutic options for patients with poor prognostic results remain controversial. Here, we investigated whether early intervention with intratympanic steroid therapy (ITST) is an effective treatment for Bell's palsy patients with poor electrodiagnostic test results (≤ 10% electroneurography value). Patients in the concurrent ITST group (n = 8) received the standard systemic dose of prednisolone (410 mg total) and intratympanic dexamethasone (16.5 mg total) and those in the control group (n = 21) received systemic prednisolone at the standard dose or higher (average dose, 605 ± 27 mg). A year after onset, the recovery rate was higher in the ITST group than in the control group (88% vs 43%, P = 0.044). The average House-Brackmann grade was better in the concurrent ITST group (1.13 ± 0.13 vs 1.71 ± 0.16, P = 0.035). Concurrent ITST improves the facial nerve outcome in patients with poor electroneurography test results, regardless of whether equivalent or lower glucocorticoid doses were administered. This may be ascribed to a neuroprotective effect of ITST due to a higher dose of steroid reaching the lesion due to dexamethasone transfer in the facial nerve.
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Affiliation(s)
- Akira Inagaki
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Sachiyo Katsumi
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shinji Sekiya
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shingo Murakami
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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